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2015-025D
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2015-025D
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Last modified
4/2/2018 3:40:21 PM
Creation date
4/26/2016 11:52:47 AM
Metadata
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Template:
Official Documents
Official Document Type
Agreement
Approved Date
02/17/2015
Control Number
2015-025D
Agenda Item Number
8.G.
Entity Name
Blue Cross and Blue Shield of Florida
Subject
Administrative Services Agreement
Financial Arrangements
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Late Enrollment Penalty ("LEP") means an amount added to the Part D Premium of an <br />individual who did not have Part D coverage or other creditable prescription drug plan when the <br />individual first became eligible for Part D or who had a break in Part D or other creditable <br />prescription drug coverage for at least 63 days. <br />Low Income Subsidy ("LIS") means the premium subsidy amount paid to us by CMS for <br />qualifying Covered Persons with Medicare Part D coverage. <br />Medicare Plan means the group Medicare Advantage Plan, Medicare Advantage Prescription <br />Drug Plan, and/or standalone Medicare Prescription Drug Plan that you select. <br />Premium means the amount required to be paid by the Group to us for coverage under this <br />Agreement. <br />Service Area means a geographic area where a Medicare Plan accepts members. <br />SECTION 3: ELIGIBILITY, ENROLLMENT, AND DISENROLLMENT <br />A. Eligibility Determination <br />Determination of whether an individual is an Eligible Retiree or Eligible Dependent will be a <br />two-step process: <br />1. You will determine whether the individual is eligible to participate in the retiree group <br />health benefit plan that you sponsor. For individuals meeting your eligibility criteria, you <br />will promptly forward completed applications to us. You are responsible for complying <br />with all applicable laws and regulations, including but not limited to the Employee <br />Retirement Income Security Act (ERISA) and the Internal Revenue Code, in making this <br />eligibility determination. You must also comply with all eligibility guidelines included <br />in the benefit administrative guide and Evidence of Coverage. <br />2. After receiving a complete application, we will process the application in accordance <br />with CMS Requirements. An application must be approved by us and accepted by CMS <br />for an individual to be enrolled in a Medicare Plan. <br />B. Distribution of. Enrollment Materials <br />You may only distribute materials describing the Medicare Plan that we have provided to you or <br />that we have approved in writing. You will distribute any pre -enrollment materials that we <br />provide to you to each potential enrollee before collecting enrollment applications. Nothing in <br />this Section will preclude you from making additional disclosures about your group health <br />benefit plan as applicable to comply with ERISA, such as a wrap-around summary plan <br />description or other plan document. If applicable, you are solely responsible for compliance with <br />ERISA disclosure requirements in connection with the Medicare Plan(s). <br />3 <br />
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